IV moderate sedation is a substantially more effective and safer method for controlling dental anxiety and achieving a moderate level of sedation (when compared to oral sedation and nitrous), which is why it is used heavily in periodontal offices for soft tissue surgeries. While sleep is not guaranteed, patients tend to fall into a “twilight sleep state” where they are still able to respond to commands by the provider. Depending on the combinations of the drugs being used for the sedation, many patients describe a sensation of extreme relaxation to an intensely euphoric feeling, with almost all reporting that they don’t remember anything or only bits and pieces of the procedure. These effects are largely due to the titrated sedative drugs (Midazolam) or the opioid effects of the narcotics (Fentanyl or Demerol) used in combination. The most amazing thing we find with IV sedation is the ability to watch the drugs work in real-time.
A pre-op appointment is required in which a patient’s health history is reviewed and a simple physical evaluation is completed along with pre-op vitals (HR/BP, ECG, O2-Sat). A separate appointment is made for the dental procedure (with the IV sedation). There are no same-day appointments for IV sedation at Story City Dental. Not everyone is a good candidate for IV sedation. People who have an uncontrolled systemic disease, sleep apnea, a BMI over 40 or an inability to breathe through the nose (such as cold or cough) should not receive IV sedation.
The day of the procedure, the patient will be connected to a monitor for heart rhythm, heart rate, blood pressure, oxygen saturation as well as breathing and CO2 output. An IV line is then started in either the hand or arm. All drugs used for the sedation are administered through a port in the IV line. Due to the speed of onset of these drugs, they can be titrated to achieve the desired depth of sedation in real time and reversed in the same fashion should an emergency arise. After a desired level of sedation is achieved, the mouth will be numbed with a local anesthetic for the planned procedure. Once the procedure is completed, and most of the sedative effects have worn off (relatively quickly since it’s IV), the patient must be driven home by their escort. The amnesic effects of the drug last for the duration of the procedure and for some time afterwards. Almost all patients we talk to at post-op appointments tell us they remember very little from the procedure, and it made the dental visit very relaxing. This service can be provided by either Dr Binkowski or one our CRNAs.